Application value of dual-source CT dual-energy scanning mode in early endovascular interventional treatment of acute ischemic stroke_West China Medical Journal

Authors：

ZHANG Ping ,  LI Jie

Department of Neurology, People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding?author：

LI Jie, Email: lijie860114@163.com

Keywords：

Acute ischemic stroke; Endovascular interventional therapy; Dual-source CT dual-energy scan

DOI：

10.7507/1002-0179.202005085

Video：

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Early endovascular interventional therapy can effectively improve the prognosis of patients with acute ischemic stroke. Dual-source CT dual-energy scanning, as a new CT imaging technology developed rapidly in recent years, with its unique technical characteristics and advantages, shows potential and application prospects in early endovascular interventional therapy of acute ischemic stroke. This article discusses the value of dual-source CT dual-energy scanning in the early screening and evaluation, the identification of postoperative iodine contrast agent extravasation and secondary cerebral hemorrhage, and the prediction of prognosis of patients with early endovascular interventional treatment of acute ischemic stroke. The purpose is to provide a theoretical basis for better application of dual-source CT dual-energy scanning in early endovascular interventional treatment of acute ischemic stroke.

Citation： ZHANG Ping, LI Jie. Application value of dual-source CT dual-energy scanning mode in early endovascular interventional treatment of acute ischemic stroke. West China Medical Journal, 2020, 35(6): 719-723. doi: 10.7507/1002-0179.202005085 Copy

1.	Wang W, Jiang B, Sun H, et al. Prevalence, incidence and mortality of stroke in china: results from a nationwide population-based survey of 480, 687 adults. Circulation, 2017, 135(8): 759-771.
2.	Wardlaw JM, Murray V, Berge E, et al. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev, 2014, 29(7): CD000213.
3.	de Los Ríos la Rosa F, Khoury J, Kissela BM, et al. Eligibility for intravenous recombinant tissue-type plasminogen activator within a population: the effect of the European cooperative acute stroke (ECASS) Ⅲ trial. Stroke, 2012, 43(6): 1591-1595.
4.	Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet, 2016, 387(10015): 251-272.
5.	Heiss WD. Malignant MCA infarction: pathophysiology and imaging for early diagnosis and management decisions. Cerebrovasc Dis, 2016, 41(1/2): 1-7.
6.	Alexandrov AV. Current and future recanalization strategies for acute ischemic stroke. J Intern Med, 2010, 267(2): 209-219.
7.	Nikoubashman O, Jungbluth M, Schürmann K, et al. Neurothrombectomy in acute ischemic stroke: a prospective single-centre study and comparison with a randomized controlled trials. Eur J Neurol, 2016, 23(4): 807-816.
8.	Albers GW, Lansberg MG, Kemp S, et al. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFFUSE 3). Int J Stroke, 2017, 12(8): 896-905.
9.	Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med, 2015, 372(11): 1019-1030.
10.	鄭玲, 顧海峰, 楊剛, 等. 雙源 CT 成像技術及其臨床應用的新進展. 醫學研究生學報, 2008, 21(4): 404-407, 411.
11.	林曉珠, 沈云, 陳克敏. CT 能譜成像的基本原理與臨床應用研究進展. 中華放射學雜志, 2011, 45(8): 798-800.
12.	Lenga L, Leithner D, Peterke JL, et al. Comparison of radiation dose and image quality of contrast-enhanced dual-source CT of the chest: single-versus dual-energy and second-versus third generation technology. AJR Am J Roentgenol, 2019, 212(4): 741-747.
13.	沈宓, 王晨, 劉光銳, 等. 國家卒中策略的實施—影像指南. 中國卒中雜志, 2008, 3(11): 845-854.
14.	Rennert RC, Wali AR, Steinberg JA, et al. Epidemiology, nature history, and clinical presentation of large vessel ischemic stroke. Neurosurgery, 2019, 85(suppl_1): S4-S8.
15.	中華醫學會神經病學分會, 中華醫學會神經病學分會神經血管介入協作組. 急性缺血性腦卒中早期血管內介入治療流程與規范專家共識. 中華神經科雜志, 2017, 50(3): 172-177.
16.	郭元星, 歐陜興. 雙源 CT 在頭頸部血管成像中的應用. 華南國防醫學雜志, 2011, 25(2): 173-175.
17.	Postma AA, Hofman PA, Stadler AA, et al. Dual-energy CT of the brain and intracranial vessels. AJR Am J Roentgenol, 2012, 199(5 suppl): S26-S33.
18.	白愛國, 馬光慧, 滑炎卿. 雙能量 CT 血管造影的應用進展. 中華臨床醫師雜志 (電子版), 2013, 7(22): 10325-10328.
19.	Chai Y, Xing J, Gao J, et al. Feasibility of virtual nonenhanced images derived from single-source fast kVp-switching dual-energy CT in evaluating gastric tumors. Eur J Radiol, 2016, 85(2): 366-372.
20.	雷智鑫, 鄧曉鳳. 雙源 CT 雙能量去骨技術用于頭頸部血管成像中的臨床價值. 影像研究與醫學應用, 2019, 3(2): 228-229.
21.	Uotani K, Watanabe Y, Higashi M, et al. Dual-energy CT head bone and hard plaque removal for quantification of calcified carotid stenosis: utility and comparison with digital subtraction angiography. Eur Radiol, 2009, 19(8): 2060-2065.
22.	Boxerman JL, Jayaraman MV, Mehan WA, et al. Clinical stroke penumbra: use of National Institutes of Health stroke scale as a surrogate for CT perfusion in patient triage for intra-arterial middle cerebral artery stroke therapy. AJNR Am J Neuroradiol, 2012, 33(10): 1893-1900.
23.	Albers GW, Goyal M, Jahan R, et al. Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME. Ann Neurol, 2016, 79(1): 76-89.
24.	Li Z, Li H, Zhang K, et al. Improvement of image quality and radiation dose of CT perfusion of the brain by means of low-tube voltage (70 KV). Eur Radiol, 2014, 24(8): 1906-1913.
25.	Jang YM, Lee DH, Kim HS, et al. The fate of high-density lesions on the non-contrast CT obtained immediately after intra-arterial thrombolysis in ischemic stroke patients. Korean J Radiol, 2006, 7(4): 221-228.
26.	Mokin M, Kan P, Kass-Hout T, et al. Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management. Neurosurg Focus, 2012, 32(4): E2.
27.	王震汕, 陳婉琪, 黃偉鵬. 雙源 CT 雙能量物質分離技術應用現狀. 實用放射學雜志, 2019, 35(1): 146-149, 153.
28.	李清, 吳芳, 劉佳賓, 等. 雙能 CT 表現及臨床相關因素與急性缺血性腦卒中血管內介入治療后繼發腦出血關系的初步研究. 中國急救復蘇與災害醫學雜志, 2018, 13(5): 437-441.
29.	Gupta R, Phan C M, Leidecker C, et al. Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology, 2010, 257(1): 205-211.
30.	Tijssen MP, Hofman PA, Stadler AA, et al. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke. Eur Radiol, 2014, 24(4): 834-840.
31.	劉美洲, 劉輝佳, 富彥, 等. 雙源雙能量 CT 在鑒別急性缺血性腦梗死血運重建術后碘造影劑外滲和繼發腦出血中的價值. 實用醫學雜志, 2017, 33(15): 2569-2572.
32.	Shi ZS, Duckwiler GR, Jahan R, et al. Early Blood-brain barrier disruption after mechanical thrombectomy in acute ischemic stroke. J Neuroimaging, 2018, 28(3): 283-288.
33.	Renú A, Laredo C, Tudela R, et al. Brain hemorrhage after endovascular reperfusion therapy of ischemic stroke: a threshold-finding whole-brain perfusion CT study. J Cereb Blood Flow Meab, 2017, 37(1): 153-165.
34.	Renú A, Amaro S, Laredo C, et al. Relevance of blood–brain barrier disruption after endovascular treatment of ischemic stroke: dual-energy computed tomographic study. Stroke. Stroke, 2015, 46(3): 673-679.
35.	Chen Z, Zhang Y, Su Y, et al. Contrast extravasation is predictive of poor clinical outcomes in patients undergoing endovascular therapy for acute ischemic stroke in the anterior circulation. J Stroke Cerebrovasc Dis, 2020, 29(1): 104494.
36.	Djurdjevic T, Rehwald R, Knoflach M, et al. Prediction of infarction development after endovascular stroke therapy with dual-energy computed tomography. Eur Radiol, 2017, 27(3): 907-917.

1. Wang W, Jiang B, Sun H, et al. Prevalence, incidence and mortality of stroke in china: results from a nationwide population-based survey of 480, 687 adults. Circulation, 2017, 135(8): 759-771.
2. Wardlaw JM, Murray V, Berge E, et al. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev, 2014, 29(7): CD000213.
3. de Los Ríos la Rosa F, Khoury J, Kissela BM, et al. Eligibility for intravenous recombinant tissue-type plasminogen activator within a population: the effect of the European cooperative acute stroke (ECASS) Ⅲ trial. Stroke, 2012, 43(6): 1591-1595.
4. Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet, 2016, 387(10015): 251-272.
5. Heiss WD. Malignant MCA infarction: pathophysiology and imaging for early diagnosis and management decisions. Cerebrovasc Dis, 2016, 41(1/2): 1-7.
6. Alexandrov AV. Current and future recanalization strategies for acute ischemic stroke. J Intern Med, 2010, 267(2): 209-219.
7. Nikoubashman O, Jungbluth M, Schürmann K, et al. Neurothrombectomy in acute ischemic stroke: a prospective single-centre study and comparison with a randomized controlled trials. Eur J Neurol, 2016, 23(4): 807-816.
8. Albers GW, Lansberg MG, Kemp S, et al. A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFFUSE 3). Int J Stroke, 2017, 12(8): 896-905.
9. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med, 2015, 372(11): 1019-1030.
10. 鄭玲, 顧海峰, 楊剛, 等. 雙源 CT 成像技術及其臨床應用的新進展. 醫學研究生學報, 2008, 21(4): 404-407, 411.
11. 林曉珠, 沈云, 陳克敏. CT 能譜成像的基本原理與臨床應用研究進展. 中華放射學雜志, 2011, 45(8): 798-800.
12. Lenga L, Leithner D, Peterke JL, et al. Comparison of radiation dose and image quality of contrast-enhanced dual-source CT of the chest: single-versus dual-energy and second-versus third generation technology. AJR Am J Roentgenol, 2019, 212(4): 741-747.
13. 沈宓, 王晨, 劉光銳, 等. 國家卒中策略的實施—影像指南. 中國卒中雜志, 2008, 3(11): 845-854.
14. Rennert RC, Wali AR, Steinberg JA, et al. Epidemiology, nature history, and clinical presentation of large vessel ischemic stroke. Neurosurgery, 2019, 85(suppl_1): S4-S8.
15. 中華醫學會神經病學分會, 中華醫學會神經病學分會神經血管介入協作組. 急性缺血性腦卒中早期血管內介入治療流程與規范專家共識. 中華神經科雜志, 2017, 50(3): 172-177.
16. 郭元星, 歐陜興. 雙源 CT 在頭頸部血管成像中的應用. 華南國防醫學雜志, 2011, 25(2): 173-175.
17. Postma AA, Hofman PA, Stadler AA, et al. Dual-energy CT of the brain and intracranial vessels. AJR Am J Roentgenol, 2012, 199(5 suppl): S26-S33.
18. 白愛國, 馬光慧, 滑炎卿. 雙能量 CT 血管造影的應用進展. 中華臨床醫師雜志 (電子版), 2013, 7(22): 10325-10328.
19. Chai Y, Xing J, Gao J, et al. Feasibility of virtual nonenhanced images derived from single-source fast kVp-switching dual-energy CT in evaluating gastric tumors. Eur J Radiol, 2016, 85(2): 366-372.
20. 雷智鑫, 鄧曉鳳. 雙源 CT 雙能量去骨技術用于頭頸部血管成像中的臨床價值. 影像研究與醫學應用, 2019, 3(2): 228-229.
21. Uotani K, Watanabe Y, Higashi M, et al. Dual-energy CT head bone and hard plaque removal for quantification of calcified carotid stenosis: utility and comparison with digital subtraction angiography. Eur Radiol, 2009, 19(8): 2060-2065.
22. Boxerman JL, Jayaraman MV, Mehan WA, et al. Clinical stroke penumbra: use of National Institutes of Health stroke scale as a surrogate for CT perfusion in patient triage for intra-arterial middle cerebral artery stroke therapy. AJNR Am J Neuroradiol, 2012, 33(10): 1893-1900.
23. Albers GW, Goyal M, Jahan R, et al. Ischemic core and hypoperfusion volumes predict infarct size in SWIFT PRIME. Ann Neurol, 2016, 79(1): 76-89.
24. Li Z, Li H, Zhang K, et al. Improvement of image quality and radiation dose of CT perfusion of the brain by means of low-tube voltage (70 KV). Eur Radiol, 2014, 24(8): 1906-1913.
25. Jang YM, Lee DH, Kim HS, et al. The fate of high-density lesions on the non-contrast CT obtained immediately after intra-arterial thrombolysis in ischemic stroke patients. Korean J Radiol, 2006, 7(4): 221-228.
26. Mokin M, Kan P, Kass-Hout T, et al. Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management. Neurosurg Focus, 2012, 32(4): E2.
27. 王震汕, 陳婉琪, 黃偉鵬. 雙源 CT 雙能量物質分離技術應用現狀. 實用放射學雜志, 2019, 35(1): 146-149, 153.
28. 李清, 吳芳, 劉佳賓, 等. 雙能 CT 表現及臨床相關因素與急性缺血性腦卒中血管內介入治療后繼發腦出血關系的初步研究. 中國急救復蘇與災害醫學雜志, 2018, 13(5): 437-441.
29. Gupta R, Phan C M, Leidecker C, et al. Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology, 2010, 257(1): 205-211.
30. Tijssen MP, Hofman PA, Stadler AA, et al. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke. Eur Radiol, 2014, 24(4): 834-840.
31. 劉美洲, 劉輝佳, 富彥, 等. 雙源雙能量 CT 在鑒別急性缺血性腦梗死血運重建術后碘造影劑外滲和繼發腦出血中的價值. 實用醫學雜志, 2017, 33(15): 2569-2572.
32. Shi ZS, Duckwiler GR, Jahan R, et al. Early Blood-brain barrier disruption after mechanical thrombectomy in acute ischemic stroke. J Neuroimaging, 2018, 28(3): 283-288.
33. Renú A, Laredo C, Tudela R, et al. Brain hemorrhage after endovascular reperfusion therapy of ischemic stroke: a threshold-finding whole-brain perfusion CT study. J Cereb Blood Flow Meab, 2017, 37(1): 153-165.
34. Renú A, Amaro S, Laredo C, et al. Relevance of blood–brain barrier disruption after endovascular treatment of ischemic stroke: dual-energy computed tomographic study. Stroke. Stroke, 2015, 46(3): 673-679.
35. Chen Z, Zhang Y, Su Y, et al. Contrast extravasation is predictive of poor clinical outcomes in patients undergoing endovascular therapy for acute ischemic stroke in the anterior circulation. J Stroke Cerebrovasc Dis, 2020, 29(1): 104494.
36. Djurdjevic T, Rehwald R, Knoflach M, et al. Prediction of infarction development after endovascular stroke therapy with dual-energy computed tomography. Eur Radiol, 2017, 27(3): 907-917.

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